The little known trauma of anaesthesia awareness

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For most undergoing major surgery, the operation takes place whilst the patient is fast asleep. The surgery is carried out whilst you are in a state of controlled unconsciousness, ensuring you are unaware of the surgery and therefore unable to feel pain. In most cases, the administration of general anaesthetic runs smoothly. But what happens when it goes wrong?

Incidents of waking up during surgery, a rare condition known as ‘anaesthesia awareness’ occurs in about 300 people per year in the United Kingdom. General anaesthesia constitutes a cocktail of intravenous drugs including pain relief, sedation to send the patient to sleep, and muscle paralytic to stop them from moving. When the dosage of sedation is too low, the patient can wake up. However, paralysis will prevent the patient from being able to communicate this.

Experiences of anaesthesia awareness differ greatly, with varying degrees of severity. Not all episodes during anaesthesia are distressing or painful. In fact, over half of them are short-lived, with patients able to recall voices or surroundings but no feeling of pain. Such experiences may not be associated with negative recollections or cause long-term psychological problems.

Other experiences have proven more traumatic. Some patients were able to feel excruciating pain during their procedure. June Carson, who was undergoing surgery on her stomach, was given an insufficient dosage of sedation and pain relief. She remembers the agony and sheer terror she felt from the incisions made in her abdomen, before incurring a heart attack fifteen minutes into the operation from shock. Fortunately, doctors were able to revive her with a shot of adrenaline. Although June is unable to describe the extent of her pain, she compares the ordeal to being tortured.

According to Jaideep Pandit, consultant anaesthetist at Oxford University, surgery can become problematic when paralytics are administrated, as the patient is unable to move to alert the doctors that they are waking up. Instead, doctors must rely on subtle and often unreliable methods of monitoring consciousness. An increase in blood pressure or heart rate may provide the doctors with evidence of this; however drugs given before or during the surgery may block the body’s stress response.

Brain monitors to track electrical activity in the brain have been suggested as a solution to this problem. Doctors can use these monitors to ensure brain activity is below a certain level during an operation. However, according to Pandit, such methods are still inaccurate and therefore have not been widely implemented.

Anaesthesia awareness may cause devastating psychological affects. The requirement of prolonged psychological or psychiatric care is required by 40% of patients following such an ordeal. It is the feeling of paralysis, rather than the pain itself, that has proven to be the most psychologically scarring aspect for many patients.

This sense of helplessness during the procedure, as well as acute fear and panic, has led to the development of PTSD in a large number of cases. The symptoms of PTSD may include re-experience of the trauma, nightmares and panic attacks. Anaesthesia awareness advocate Carol Weihrer, whose sedation failed her during an operation to remove her right eye, explains that people’s lives have been ruined from such an ordeal, and has even been identified as a cause of suicide. Weihrer herself suffers vivid flashbacks that transport her back to the operating table, and has not been able to sleep in a bed for nearly seven years for fear of lying down.

The Joint Commission issued an alert in 2004, labelling anaesthesia awareness as an ‘under-recognised and undertreated’ problem in health care organisations. Such experiences may be dismissed by doctors as dreams or hallucinations, particularly if directly after the operation the patient appears outwardly fit and well. Research shows that early counselling after an episode of awareness is vital to lessen feelings of stress, confusion or trauma, and victims of anaesthesia awareness should not be afraid to speak out about their experiences.